Garrison, NY) "Since my diagnosis, I had been immersed in a crash course in real-world medical ethics," writes Rebecca Dresser, editor of Malignant: Medical Ethicists Confront Cancer, published by Oxford University Press. She and five other bioethicists discuss their personal experiences with cancer or caring for loved ones with the disease, with lessons for doctors and nurses, patients, and caregivers.
Dresser, the Daniel Noyes Kirby Professor of Law and Professor of Ethics in Medicine at Washington University in St. Louis, and most of the other authors are Hastings Center Fellows.
The writers explore the many ways that their experiences made them reassess their views on bioethics issues, including respect for patient autonomy, doctor-patient decision-making, and the need to avoid unnecessary care. Shared decision-making, for example, long advocated by bioethicists, proved difficult in practice for Dresser and Dan W. Brock, a Hastings Center Fellow and the Frances Glessner Lee Professor of Medicine Ethics in the Department of Social Medicine and director of the Division of Medical Ethics at Harvard Medical School.
"Shared decision-making assigns more responsibility to patients, and that responsibility can be hard for patients to handle," writes Brock, adding that "medical and treatment advances often end up increasing the complexity of those decisions." While not advocating for a return to "the old days of paternalism," Brock appeals to doctors to do more than explain treatment options to patients, but also to help them understand the ways that different treatments could affect their well-being, values, and plans for the future.
In another chapter, Norman Fost, a professor of pediatrics and bioethics and director of the bioethics program at the University of Wisconsin, who has long argued that it is unethical to spend limited health care dollars on unwarranted health care, recounts how an "unnecessary" CT scan probably saved his life by identifying a small kidney cancer. While the experience caused Fost to think more personally about wasteful care, it did not change his ultimate view of it. "Because dollars are spent on unnecessary tests like the one that saved my life, health insurance is expensive, and thousands of people can't afford to pay for it," writes Fost, a Hastings Center Fellow. "The fact that my life was saved by our system does not mean it was appropriate or defensible to do so. The end does not justify the means."
The other authors are Arthur W. Frank, a professor of sociology at the University of Calgary; Leon R. Kass, a Hastings Center Fellow and the Addie Clark Harding Professor Emeritus in the Committee on Social Thought at the University of Chicago; Patricia A. Marshall, a Hastings Center Fellow and professor in the Department of Bioethics at Case Western Reserve University School of Medicine; and John A. Robertson, a Hastings Center Fellow who holds the Vinson & Elkins Chair at the University of Texas School of Law at Austin.
All royalties from the book will be donated to organizations that assist cancer patients and their families.
|Contact: Michael Turton|
The Hastings Center